Abstract
Objectives: External dacryocystorhinostomy is the traditional procedure for the management of nasolacrimal duct obstruction. The disadvantages of this approach include scarring, hemorrhage, and wound infection. Endonasal technique has the advantages of avoiding an external wound that may be prone to infection, less bleeding, limited tissue injury, and reduced postoperative stay. Various antimetabolites have been used to improve the outcome rates following dacryocystorhinostomy by reducing fibrosis at the operative site. In patients with primary acquired nasolacrimal duct obstruction: (1) Is one surgical approach (external vs endonasal) superior to the other? (2) Does the use of topical antimetabolites during the procedure lead to better success rates following the surgery?
Methods: We searched the Cochrane Controlled Trials Register, MEDLINE, and EMBASE, contacted experts, scanned conference proceedings, and hand-searched references. Stringent inclusion criteria were used, authors assessed randomized controlled trial quality, and Revman Version 4.1 was used for analysis.
Results: Seven published trials and one unpublished trial were identified that satisfied inclusion criteria. Based on one trial, the external approach has a relative benefit of 1.4 (95% CI, 1.08–1.93) over the endonasal laser procedure and 1.2 (95% CI, 0.96–1.51) over the endonasal drill approach. Based on six trials, the use of mitomycin C during external dacryocystorhinostomy provides a relative benefit (symptom relief) of 1.21 (95% CI, 1.09–1.35)
Conclusions: The results indicate that primary success rates in terms of patency and symptomatic relief are better for the external approach and use of mitomycin C provides higher symptom relief rates.